Postoperative complications of Bartholin's duct abscess. About two cases

Bartholinitis is the most common infectious vulvar disease and develops in approximately 2% of all women. The choice concerning treatment may be uneasy between medical or surgical modalities, and we have to be cautious because of the risk of severe complications associated with the procedure. We report two cases: one case of sepsis and the other one of bacterial cellulitis after Bartholin's duct abscess marsupialization. In the light of epidemiological and bacteriological date referring to Bartholinitis, we recommend a safe and effective management (particularly the use of broad-spectrum antibiotics) that we will describe.     

Sepsis after Bartholin's duct abscess marsupialization in a gravida.

BACKGROUND: Little information exists regarding sepsis following marsupialization of a Bartholin's duct abscess. We report a gravida who became septic after marsupialization. CASE: A 30-year-old primigravida at 32 weeks' gestation underwent marsupialization of a Bartholin's gland abscess. Postoperatively, she developed fever with maternal and fetal tachycardia. She was admitted to the hospital and started on broad-spectrum antibiotics. Her temperature increased to 39 degrees C, and she became hypotensive. Blood work demonstrated evidence of disseminated intravascular coagulopathy. The patient was stabilized with aggressive fluid resuscitation, antibiotics, transfusion of blood products and oxygen therapy. Within 24 hours, the fever and coagulopathy resolved. She was discharged on postoperative day 5 and gave birth without complications at 38 weeks' gestation. CONCLUSION: Pregnant women undergoing marsupialization of a Bartholin's gland abscess should be considered at high risk and managed accordingly.     

Aerobic and anaerobic microbiology of Bartholin's abscess

Aspirates of pus from an abscess of Bartholin's gland in 28 patients were studied for aerobic and anaerobic bacteria. Bacterial growth was obtained on culture in 26 specimens. A total of 67 bacterial isolates (43 anaerobic and 24 aerobic and facultative) were recovered, accounting for 2.6 isolates per specimen (1.7 anaerobic and 0.9 aerobic and facultatives). Anaerobic bacteria only were present in eight patients, aerobic and facultatives in five and mixed aerobic and anaerobic flora in 13. Single bacterial isolates were recovered in six infections. The predominant anaerobic organisms were Bacteroides species (23 isolates, including six Bacteroides melaninogenicus group, five Bacteroides fragilis group and four Bacteroides bivius) and Peptostreptococcus species. The predominant aerobic and facultative bacteria were Escherichia coli and Neisseria gonorrhoeae. In this study, the polymicrobial nature of abscess of Bartholin's gland is highlighted.     

Unusual presentation of Bartholin's gland duct cysts: anterior expansions

The medical records of 32 patients who underwent surgery for a vulvar mucinous cyst located between the urethral meatus and the fourchette were reviewed. Nineteen (59%) patients had been referred to our centre because of cyst recurrence after incision or excision. The majority of the cysts were lined by a single layer of tall columnar cells with zones of squamous metaplasia. Subacute or chronic bartholinitis was demonstrated in 94% of the cases demonstrating that these cysts were anterior expansions of Bartholin's gland duct cysts. No ipsilateral recurrence was observed after cyst and gland excision.     

Urinary retention as the presentation of Bartholin's duct cyst in a neonate

Patients with a vaginal mass (large Bartholin's duct cyst) associated with a contralateral renal cyst and hydroureteronephrosis are unable to urinate. While occasionally seen in adults, Bartholin's duct cyst is rare in neonates. The origins of Bartholin's and Gartner's cysts can be traced to the mesonephric duct. Given the rarity of these cysts, there is significant confusion regarding their diagnosis, management, and prognosis. Here, we present the first report of an interlabial mass as a Bartholin's duct cyst in a neonate. The treatment of vaginal cysts is also discussed.     

Necrotizing fasciitis of the perineum secondary to a surgical treatment of Bartholin's gland abscess

Necrotizing fasciitis of the perineum is a rare but of fast evolution, and potentially fatal infectious disease process. It is characterized by progressive inflammation and extensive necrosis of subcutaneous tissue involving the fascia and other adjacent tissues. This infection may be idiopathic or secondary to local trauma or pelvic surgery. Its mortality rate is 20%. We report a case of necrotzing fasciitis of the perineum in a 34-year-old woman following incision and drainage of Bartholin's gland abscess. Streptococcus A, Proteus mirabilis, Escherichia coli, and Candida albicans were isolated. Intravenous broad spectrum antibiotic therapy was promptly instituted. Concurrent surgical debridement of all necrotic areas was required. Post debridement therapy required a long period of dressing changes until cicatrisation. Necrotizing fasciitis of the perineum is a surgical emergency. Early diagnosis and prompt aggressive debridement are the keys to successful management.     

Recurrent squamous cell carcinoma of the Bartholin's duct treated with en bloc resection.

Bartholin's gland carcinomas are a rare entity. A case of a recurrent Bartholin's gland carcinoma is described. These neoplasms have a myriad of treatment options for primary therapy but there is a paucity of information regarding treatment for a lethal recurrence. The patient's primary therapy consisted of an initial wide local excision followed by radiation therapy with chemosensitization. She was disease-free for 2 years before her recurrence. A novel treatment approach incorporating a mulitdisciplinary en bloc radical surgery is described. The patient is alive and well without evidence of disease at 22 months.     

The simple outpatient management of Bartholin's abscess using the Word catheter: a preliminary study

INTRODUCTION: Bartholin's cysts/abscess affects 2% of women. Conventional treatment is marsupialisation under general anaesthetic. We evaluated a conservative approach in a non-randomised prospective interventional study over 12 months. METHOD: Women with a Bartholin's abscess were counselled and those who opted for the Word catheter (WC) had it inserted under local anaesthetic (follow up at one week and four weeks, when catheter was removed). Women recorded pain scores and completed a qualitative questionnaire and had telephone follow up at six months. Outcome measures were abscess resolution and acceptability of treatment. RESULTS: Fifty-eight women attended with a Bartholin's abscess requiring drainage. Twenty-three of 58 (40%) elected for marsupialisation. Thirty-five of 58 (60%) women had a WC inserted. Twenty-seven of 35 (77%) women retained their catheter for four weeks (three catheters fell out within 24 h of insertion, three catheters fell out within one week, one fell out after 11 days and there was one failed insertion). One woman had a recurrence six months after treatment. Abscess resolution occurred in 34 of 35 (97%). No woman reported significant discomfort at one week. Twenty-four of 27 women (89%) said that if they suffered a recurrence, they would have another WC inserted. Three of 27 (11%) women had intercourse within the second week of catheter insertion and reported that it was not uncomfortable. Fourteen women who had marsupialisation were traced and none had suffered a recurrence six months after treatment. CONCLUSIONS: The WC is a safe and effective treatment for a Bartholin's abscess. It may be considered as an alternative to marsupialisation.     

Aspiration and alcohol sclerotherapy: a novel method for management of Bartholin's cyst or abscess

OBJECTIVE: To investigate the efficiency and safety of alcohol sclerotherapy of Bartholin's cyst or abscess by comparing it with silver nitrate insertion. STUDY DESIGN: Twenty-two patients with unilateral Bartholin's cyst or abscess were randomized into one of the treatment groups according to diameter of cyst or abscess. Group I consisted of 12 patients who were treated with alcohol sclerotherapy and Group II included 10 patients who were treated with silver nitrate insertion. In both groups, treatments were conducted under local anesthesia and in an outpatient setting. The patients were checked for morbidity of operations every 3 days until complete healing was observed and then followed up monthly for over 24 months. RESULTS: The mean duration of procedure was 7+/-2 min in group I and 15+/-3 min in group II. Healing time was 4.8+/-1.3 days in group I and 9.2+/-2.5 days in group II. In group I although 10 patients showed complete healing without any early or late morbidity; two patients suffered from severe vulval pain, edema and echymosis, and then developed a total cyst necrosis. Healing in these patients completed with mild scar formation. Only one recurrence was documented during 24 months follow-up period. All patients in group II complained labial pain, four of them suffered from severe labial pain, edema, and echymosis. Healing in these patients was completed with moderate scar formation. Follow-up of 24 months revealed no recurrence in this group. CONCLUSION: Alcohol sclerotherapy of Bartholin's cyst or abscess is as effective as silver nitrate application and is associated with less complication. It may be ideal, safe and attractive treatment modality for this gynecological disease.     

Ultrasound imaging of Bartholin's cysts

In a prospective, randomized study, Bartholin's cysts were depicted in 36 patients by means of ultrasound imaging. Patients were requested to return for a follow-up US examination after surgery. We were able to show that Bartholin's cysts can easily be expressed with ultrasonographic techniques. In clinical practice, this approach may not only help to improve diagnostics, but may also make therapy measurable and, for the first time, objectifiable.     

Leiomyoma of Bartholin's gland]

Out of 4676 gynecological surgeries, the authors came across one case of the leiomyoma of Bartholin's gland. The clinical picture differed from that in the cystic changes of this gland by its consistency; also the skin, the surrounding tissue, and regional lymphs of the gland were not changed. The authors maintain that all tumorous changes of Bartholin's gland should be treated surgically.